Suboptimal behaviour and knowledge regarding overnight glycaemia in adults with type 1 diabetes is common

Larsson, C.; Januszewski, Andrzej S.; McGrath, Rachel T.; Ludvigsson, Johnny; Keech, Anthony; MacIsaac, Richard J; Ward, Glenn; O’Neal, David N; Jenkins, Alicia J.

doi:10.1111/imj.13798

Cited by 9 publications

(8 citation statements)

References 26 publications

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“…We demonstrated the survey feasibility and similar responses from adults with T1D in two Australian tertiary referral diabetes clinics and in a general practice (GP) clinic with a strong interest in T1D [47,48]. Whilst the average number of self-reported BG tests per day was above the recommended four tests per day, about one third of patients reported never testing their BG overnight, despite our clinicians usually recommending episodic overnight testing given the frequency and risks of nocturnal hypoglycaemia.…”

Section: A Survey To Assess Glucose Self-management Practicementioning

confidence: 87%

“…Given the frequency and risks of overnight hypoglycaemia there was an emphasis on overnight glucose control. Results have been published [47,48]. On average the 16-question survey, available on request from the authors, took ≈11 minutes to complete.…”

Section: A Survey To Assess Glucose Self-management Practicementioning

confidence: 99%

“…The 6% of patients who reported consuming complex carbohydrate alone for hypoglycaemia may have a delayed recovery from hypoglycaemia. We speculate these behaviours may relate to a need for education, lack of nearby optimal foods, a desire to return to sleep promptly and / or to prevent posthypoglycaemia hyperglycaemia [47,48].…”

Section: A Survey To Assess Glucose Self-management Practicementioning

confidence: 99%

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Type 1 Diabetes Glucose Control related Home-Based Testing: A Mini-Review of Tools and Patient Knowledge and Implementation

Jenkins¹,

Kilov²,

Scott³

et al. 2018

Madridge J Diabetes

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Background:In Type 1 diabetes (T1D) glycaemic control is key to the prevention of acute and chronic complications. An increasing array of devices is available for at-home monitoring. Tools must be used appropriately, and the information gained utilised well to maximise clinical benefit. Aims: This mini-review describes clinically available home glucose and ketone monitoring tools and discusses factors which impact glucose outcomes. Additionally, findings from the authors' surveys of T1D adults regarding glucose self-care are discussed.Results: Blood glucose strips and meters and urine glucose strips have been available for decades. More recently available are continuous glucose monitors (CGM) and flash glucose monitoring (FGM) which assess interstitial fluid glucose levels. Blood and urine ketone test-strips are also available. In surveys of adults with T1D in two tertiary referral diabetes clinics (n=205) and in general practice (GP, n=35) self-reported rates of blood glucose (BG) monitoring and glucose targets were similar, with a mean (SD) of 5.3 (2.5) tests/day. Deficits in knowledge or practice related to the care of hypothetical pre-bed BG levels and of metabolic control around illness, exercise or alcohol were common. Only about one third reported treating nocturnal hypoglycaemia with the recommended refined then complex carbohydrate. Only 66% reported having in-date ketone teststrips at home. Further education was often desired, but difficult to predict based on demographics.Conclusions: A range of tools are available to test glucose and ketone levels at home. Many adults with T1D have suboptimal knowledge and behaviour regarding glucose self-management.

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Section: A Survey To Assess Glucose Self-management Practicementioning

confidence: 87%

Section: A Survey To Assess Glucose Self-management Practicementioning

confidence: 99%

Section: A Survey To Assess Glucose Self-management Practicementioning

confidence: 99%

See 1 more Smart Citation

Type 1 Diabetes Glucose Control related Home-Based Testing: A Mini-Review of Tools and Patient Knowledge and Implementation

Jenkins¹,

Kilov²,

Scott³

et al. 2018

Madridge J Diabetes

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show abstract

“…In our recently published survey of 205 adults with T1D from two tertiary referral diabetes clinics, one third of people did not have in-date ketone testing strips. 22 In general, the capability to measure ketones requires the person to carry with them an additional device, with testing strips with a finite shelf-life as a precaution in the event of circumstances which occur infrequently and unexpectedly. In addition, finger-prick blood testing is painful and requires a conscious decision and actions on the part of the person.…”

Section: Ketone Sensing Versus Blood Ketone Measurementsmentioning

confidence: 99%

The Clinical Case for the Integration of a Ketone Sensor as Part of a Closed Loop Insulin Pump System

Lee

Paldus

Krishnamurthy

et al. 2019

J Diabetes Sci Technol

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Closed loop (CL) systems deliver insulin with a rapid onset and offset in action. Although favorable overall, the absence of a long-acting insulin increases the risk of diabetic ketoacidosis (DKA) which can occur with insulin delivery failure, acute illness, low carbohydrate diets, sodium glucose-linked transporter inhibitors, and high intensity exercise. A CL system relying entirely on interstitial glucose measurements may not provide an alert for DKA and many people with type 1 diabetes (T1D) do not carry a blood ketone meter and test-strips. Ketone sensing is theoretically feasible. A multianalyte platform incorporating a ketone sensor could provide an additional CL input without an increase in burden for the person with T1D, warning of impending DKA to allow remedial action to be taken. We outline the clinical case for inclusion of continuous ketone sensing as part of future CL systems.

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“… 13 These measurements do not indicate the onset of ketosis or ketoacidosis, but rather confirm if ketosis or ketoacidosis is already in progress and may require medical attention. In real world clinical care, patients seldom check their ketone levels as recommended by the health care professional because of the lack of availability of the in-date strips at the time of need 14 and the fingerstick blood testing requires a conscious action by the patient. Under multiple scenarios, such as failure of insulin delivery, sick days, low carbohydrate intake, use of SGLT2 inhibitors, high risk patients such as people with T1D, or recurring DKA, and so on, patients would benefit from a continuous ketone sensor.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Continuous Ketone Monitoring in Subcutaneous Tissue using a Ketone Sensor

Alva

Castorino

Cho

et al. 2021

J Diabetes Sci Technol

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Background: The feasibility of measuring β-hydroxybutyrate in ISF using a continuous ketone monitoring (CKM) sensor using a single calibration without further adjustments over 14 days is described. Methods: A CKM sensor was developed using wired enzyme technology with β-hydroxybutyrate dehydrogenase chemistry. In vitro characterization of the sensor was performed in phosphate buffered saline at 37°C. In vivo performance was evaluated in 12 healthy participants on low carbohydrate diets, who wore 3 ketone sensors on the back of their upper arms to continuously measure ketone levels over 14 days. Reference capillary ketone measurements were performed using Precision Xtra® test strips at least 8 times a day. Results: The sensor is stable over 14 days and has a linear response over the 0-8 mM range. The operational stability of the sensor is very good with a 2.1% signal change over 14 days. The first human study of the CKM sensor demonstrated that the sensor can continuously track ketones well through the entire 14 days of wear. The performance with a single retrospective calibration of the sensor showed 82.4% of data pairs within 0.225 mM/20% and 91.4% within 0.3 mM/30% of the capillary ketone reference (presented as mM at <1.5 mM and as percentage at or above 1.5 mM). This suggests that the sensor can be used with a single calibration for the 14 days of use. Conclusions: Measuring ketones in ISF using a continuous ketone sensor is feasible. Additional studies are required to evaluate the performance in intended patient populations, including conditions of ketosis and diabetic ketoacidosis.

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Suboptimal behaviour and knowledge regarding overnight glycaemia in adults with type 1 diabetes is common

Abstract: Many adults with T1D have suboptimal knowledge and behaviour regarding overnight BG self-management. A survey, piloted herein, may facilitate the identification of patients who could benefit from further education.

Cited by 9 publications

References 26 publications

Type 1 Diabetes Glucose Control related Home-Based Testing: A Mini-Review of Tools and Patient Knowledge and Implementation

Type 1 Diabetes Glucose Control related Home-Based Testing: A Mini-Review of Tools and Patient Knowledge and Implementation

The Clinical Case for the Integration of a Ketone Sensor as Part of a Closed Loop Insulin Pump System

Feasibility of Continuous Ketone Monitoring in Subcutaneous Tissue using a Ketone Sensor

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